Patient dumping is not alternative to good discharge plan

By | 2020-06-22T13:07:07-04:00 March 9th, 2018|4 Comments

Editor’s note: Author, Jennifer Mensik, does not endorse, recommend or favor any program, product or service advertised or referenced on this website, or that appear on any linkages to or from this website.

We have all seen the story or heard of a similar one:  A woman in a hospital gown being wheeled to the bus stop by a security guard in freezing temperatures.

A nurse might have been the hospital representative who co-signed the final discharge paper before this patient was rolled out into the cold. If this was your patient, what would you be thinking at this point? Would you consider this an appropriate discharge?

Many consider this act “patient dumping.” Patient dumping is when a hospital capable of providing necessary medical care transfers a patient to another facility or turns them away due to inability to pay for services, as well as a premature discharge of a Medicare or indigent patient for economic reasons.

Because of this, a 1986 U.S. federal rule requires hospitals to advise Medicare patients upon admission of their right to challenge a discharge. However, this applies to Medicare patients only. Patient dumping is unfortunate, and it happens across the U.S.

Discharge planning is your responsibility, too

Hospitals also need to comply with section 482.43: Condition of participation on discharge planning. This states a hospital must have in effect a discharge planning process that applies to all patients and identifies at an early stage in the hospitalization all patients who are likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning.

You might be thinking, “I am not the case manager or discharge RN for the patient.” But does that relieve you of the responsibility to plan appropriate care as the patient’s primary care nurse?

Based on the American Nurses Association Scope and Standards of Practice, you are responsible as the patient’s nurse — part of the team that assesses and plans for the patient’s care. It is your responsibility as the nurse involved with the patient’s care to appropriately assess and address healthcare needs.

Additionally, you must consider your professional and legal responsibility when it comes to discharging a patient who may not have had appropriate discharge planning.

Consider the following to help guide you in the discharge process:

1 – Question the discharge plan if you do not believe it is appropriate.

2 – Do request a social work or case manager consult if the patient has not been seen by either.

3 – Request a patient care conference and ask what the plan is for this patient.

4 – Read and understand your hospital’s discharge policy.

5 – Document in the patient record your input into the discharge planning.

6 – Use the chain of command in your organization if the patient’s issues are not sufficiently addressed.

7 – Understand your hospitals’ charity care options (i.e. taxi and bus vouchers).

8 – Start a charity closet with unisex clothing, socks, shoes and warm clothing items that can be given to patients being discharged without a place to go.

Recognize a patient may be discharged to no setting if they are homeless, and that in and of itself is not an unsafe discharge. Fully assess the patient’s clinical and social needs and plan for community resources, as appropriate, that exist in your community.

Now, what shouldn’t you do?

1 – Don’t think discharge planning is someone else’s responsibility, it’s yours as much as anyone else’s.

2 – Don’t justify an unsafe discharge because they are considered a frequent flyer in the system.

3 – Don’t discharge a patient you believe is going to be unsafe with unmet health and social needs.

This is a complex problem, but patient dumping should never be considered the solution. Many hospitals struggle to find adequate post-hospital clinical or social support in the community for some patients, placing increased burden on the nurse and the hospital. Remember, as the patient’s nurse, you are his or her advocate. You play an important role in the care of this patient, including the discharge.

Courses related to ‘discharge planning’

WEB363: Health Literacy and Discharge Education: I Didn’t Understand
(1 contact hr)

How many times have you considered whether a patient truly understood or would remember how to follow through with discharge instructions or prescribed medication instructions? Despite verbalization of understanding, how can you reinforce patient comprehension? The US Department of Health and Human Services discusses how those with literacy proficiency can still struggle with health literacy. When a patient or client struggles with both basic literacy and health literacy, much support is needed to help facilitate understanding of health information. Join this webinar to help increase your understanding of the state of health literacy and learn how to educate more efficiently.

CE696: Transitions of Care
(1 contact hr)

Nearly one in five Medicare beneficiaries discharged from the hospital is readmitted within 30 days of discharge at a cost of $26 billion a year. Three-quarters of those readmissions are considered potentially preventable, representing an estimated $12 billion in Medicare spending. While not a new problem, the Affordable Care Act has provisions targeted at changing this long-standing problem that affects patient outcomes and increases healthcare system costs. This program will familiarize nurses with the concept of care transitions and ways to improve outcomes and decrease avoidable readmissions.

CE169-60: Managed Care
(1 contact hr)

For nurses, the fallout from healthcare reform and the growth of managed care has not subsided. These issues have a daily impact on practice by shortening lengths of hospital stays and causing the earlier discharge of patients who require longer and more intensive care once they reach home. These changes challenge nurses and other providers to work harder, smarter and differently from traditional practice. This module addresses the origins, types and terminology associated with managed care programs.


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About the Author:

Jennifer Mensik, PhD, RN, FAAN
Jennifer Mensik, PhD, RN, NEA-BC, FAAN, is division director of care management at Oregon Health and Science University and instructor for Arizona State University College of Nursing and Health Innovation DNP program. She also is treasurer for the American Nurses Association. Formerly, Mensik was vice president of CE programming for published by OnCourse Learning. A second-edition book she authored, "The Nurse Manager's Guide to Innovative Staffing," won third place in the leadership category for the American Journal of Nursing Book of the Year Awards 2017. Author, Jennifer Mensik, does not endorse, recommend or favor any program, product or service advertised or referenced on this website, or that appear on any linkages to or from this website.


  1. Avatar
    Renee Norris November 18, 2018 at 1:40 am - Reply

    I was in the hospital and a nurse gave me a Norco and Asuma one hour later they discharged me with no way home other than me driving did not offer me any comfort wish no type of discharging plan told the doctor I was dizzy and sick and the cardiologists said I can stay till the morning he did not care they said I just had to leave cuz nothing was wrong with my heart I called the police and ask them was it legal for me to drive on such drugs they said no it was getting dark I cannot see in the dark and nor do I drive in the dark I came very close to hitting a car in the back I was very afraid I live alone I told the doctors why can’t I stay till the morning he said no he did not care I said I will call me a lawyer she said go ahead because I said this is dumping how can you put me out of the hospital on drugs and I can’t drive like this the charge nurse and the doctor did not care no one tried to help me at all and this is at Huntington Beach Hospital in the City of Huntington Beach California .

  2. Avatar
    Loretta Vukeles May 8, 2019 at 9:15 pm - Reply

    Your leading statement that a patient is being wheeled by a security guard to a bus stop in freezing weather is used to sensationalize the situation. As you mention in your article, a discharge is allowable to the streets and it is not an unsafe discharge. Many factors may have lead up to that picture that are missed when a snap judgement is made. The fact that it is freezing cannot be controlled by anyone. Perhaps their loaner closet was empty and there was nothing to provide. The security guard was taking them to a bus stop, they may have at least had a ticket to get home. The term “dumping” is misused in this article as EMTALA was to protect patients from being denied medical treatment or being shuttled from one hospital to another to get it. It was not designed to prevent hospitals from discharging a patient. Hospitals cannot keep every patient for as long as the patient believes they need to stay or there will be no beds available for the new acute patients. The bigger question is why is the hospital responsible to heal all social ills? Where are we holding communities accountable?

  3. Avatar
    JtAlmond August 1, 2019 at 8:52 pm - Reply

    All state institutions in Montana as per policy will buy an inmate, unless he or she has funds on the books to purchase a ticket themselves, a bus ticket to any jurisdiction in the lower 48 states. This includes Montana State Prison, Crossroads Correctional a private prison in Shelby, MT. The inmates overwhelmingly have discharged their entire sentence and have no more required state supervision. There are pre-release centers in the state but only a small percentage of inmates can make use of such limited programming. There is no re-entry programming for these former inmates such as drug rehab, jobs placement, or housing. Most of the re-entry programming is directed to male prisoners leaving the growing number of females inserted. This has caused a high amount of recidivism. One notable case involved a discharged male committing a deliberate homicide within 24 hrs of his release. The Montana State Hospital, as per policy hauls newly released patients to a nearby town where they may or may not utilize a bus ticket furnished by the state to virtually any destination they, or hospital staff choose. Montana has distinct seasons. In just about every case the seasons have changed during a persons incarceration. Many former inmates are not dressed in seasonable clothing upon release from custody. Many lawsuits over improper discharge have been dismissed by the court as frivolous.

  4. Avatar
    noname December 6, 2019 at 5:42 am - Reply

    Fifth, and following on from the above, the findings suggest that within three of the study sites certain actors were identified with distinct roles and responsibilities that involved working across established occupational and organisational boundaries, often with the express purpose of supporting hospital discharge. At the Glipton stroke and orthopaedic units, clearly designated discharge liaison nurses helped co-ordinate ward-based planning activities, and also carried out an outreach role by acting as a point of contact and knowledge sharing with external agencies. At the Farnchester stroke unit, the community stroke nurse provided a similar in-reach role by liaising with ward-based staff and families to provide more appropriate care following discharge. These key actors made two significant contributions to the patterns of knowledge sharing and hospital discharge. First, they acted as boundary spanners and knowledge brokers , working across and helping to close the gaps between occupational groups. In Glipton, this involved co-ordinating the work of doctors, nurses and therapists in everyday decision-making processes and weekly MDTs, where they often took leadership or oversight for discharge processes. They also helped co-ordinate the interactions between health and social care agencies through mediating and reconciling the distinct modes of working or bureaucratic procedures, and acting more directly as a go-between in complex decision-making processes. In other words, they provided an important knowledge-brokering role by helping to get the right knowledge to the right people, at the right time. Through these roles, these actors became important repositories of knowledge or knowledge resources . For example, the community stroke nurse at Farnchester had a developed appreciation of local housing issues or support services and the discharge liaison nurses at Glipton were skilled in navigating the local arrangements for community care. As such, they provided essential know-how and experiential knowledge for the wider constellation of actors and agencies about how to plan and progress hospital discharge. Looking at the range of situations and opportunities for knowledge sharing, these individuals often had an integral role in the discrete patterns of knowledge sharing and decision-making and, more importantly, acted as a link and source of continuity between these different situations.

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